COVID-19 lockdown and distressed reverse migration enhance human-tiger conflict in Sundarban: An eco-psychiatric observation.

COVID-19 lockdown enforced distressed reverse migration in Sundarban, which caused an unprecedented population addition to the already devastated fragile Sundarban ecosystem. Acute poverty and food crisis prompted many migrants to explore forest-based living, thus enhancing fatal human-tiger conflicts. Families of deceased migrants face significant mental health trauma and catastrophic psychosocial consequences.

Individualized Homeopathic Medicines in the Treatment of Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled, Pilot Trial.

INTRODUCTION: Evidence favoring homeopathy in generalized anxiety disorder (GAD) remains scarce. The objective of this pilot trial was to test feasibility of a definitive trial in future. We also experimented whether individualized homeopathic medicines (IH) plus psychological counseling (PC) can produce significantly different effects beyond placebo plus PC in the treatment of GAD. METHODS: A double-blind, randomized, placebo-controlled, parallel arm, pilot trial was conducted on 62 GAD patients at the National Institute of Homoeopathy, India. GAD-7 questionnaire and Hamilton Anxiety Scale (HAM-A) were used as the primary and secondary outcomes, respectively, measured at baseline and 3 months. Patients received either IH plus PC (n = 31) or identical-looking placebo plus PC (n = 31). Intention-to-treat sample was analyzed to detect group differences using unpaired t tests. RESULTS: Recruitment and retention rates were 56 and 90%, respectively. Mean age was 31.5 years; 56.5% were male. GAD-7 reductions were non-significantly higher in IH than placebo (p = 0.122). Group differences on HAM-A favored IH significantly (p = 0.018). Effect sizes were small to medium. Calcarea carbonica was the most frequently indicated medicine. No serious adverse events happened. CONCLUSIONS: A small but positive direction of anxiolytic effect was observed favoring homeopathy over placebo. A definitive trial appeared feasible in future.

Stigma of tiger attack: Study of tiger-widows from Sundarban Delta, India.

AIMS: Human-tiger conflict (HTC) is a serious public health issue in Sundarban Reserve Forest, India. HTC is a continued concern for significant mortality and morbidity of both human and tiger population. This study examined 49 widows, whose husbands were killed by tigers, in order to explore the cultural stigma related with tiger-killing and consequent discrimination and social rejection. Different psychosocial aspects of community stigma associated with tiger-killings is discussed in the context of local culture. METHODS: A mix of both quantitative and qualitative methods was used in this ethnographic study in two mouzas of Sundarban adjacent to Reserve Forest, involving (1) Village Survey for Tiger-widows, (2) In-depth interview of the widows, (3) Focus Group discussions, (4) Participatory mapping and (5) Stigma assessment by using a 28 item stigma scale especially devised for this research. For comparison of stigma-burden snake-bite widows and normal widows were taken from the same community. RESULTS: Tiger-widows showed significantly higher stigma scores on all the clusters (fear, negative feelings, disclosure, discrimination, community attitudes, and spiritual dimension) than from both normal and snake-bite widows. They also showed higher total stigma score (65.9 ± 9.8) than normal widows (35.8 ± 8.0) and snake-bite widows (40.1 ± 7.1) and this difference was highly significant (P < 0.001). IDIs and FGDs helped to unfold the cultural construct of stigma related to tiger-killing. This can be seen in how the tiger-widows' quality of life has been negatively impacted with a multitude of post-trauma psychological scars, deprivation, abuse and exploitation. CONCLUSIONS: The study proposes that administrative strategy for sustainable alternative income generation and conservation policy with integrated participatory forest management may save both human and tiger. A community ecocultural mental health programme addressing to eradicate the cultural stigma related with tiger attack, with environmental awareness may help to reduce the social miseries of the tiger-widows.

Ecopsychosocial Aspects of Human-Tiger Conflict: An Ethnographic Study of Tiger Widows of Sundarban Delta, India.

AIMS: Human-tiger conflict (HTC) is a serious public health issue in Sundarban Reserve Forest, India. HTC is a continued concern for the significant mortality and morbidity of both human and tiger population. This is the first comprehensive report on Sundarban tiger-human conflicts and its impact on widows whose husbands were killed by tigers. The study attempts to explore the situation analysis of HTC and the aftermath of the incident including bereavement and coping, the cultural stigma related to being killed by a tiger and the consequent discrimination, deprivation, and social rejection, and the impact on the mental health of the tiger-widows. METHODS: This is a three-phase ethnographic research with a mix of quantitative and qualitative methods. In the first phase, a door-to-door village survey (3,084 households) was carried out in two villages of Sundarban, which are adjacent to the Reserve Forest, in which the incidents of human-animal conflicts and the 65 tiger-widows identified were documented. In the second phase, the 65 tiger-widows were studied to explore the ecodemography of tiger attacks and tiger-widows alongside the stigma issue by using a stigma questionnaire (n = 49). The stigma burden was compared with normal widows (n = 21) and snake-bite widows (n = 18). In the third phase, the psychosocial and cultural dimensions related to tiger attacks were studied by using in-depth interviews (IDI) of the tiger-widows, focus-group discussions (FGD), and participatory mapping in the community. Clinical examinations of the mental health of the widows were also carried out in this phase. RESULTS: The mean age of the 65 widows was 43.49 ± 9.58 years. Of this, 12.3% of the widows had remarried and only 4.6% of the widows were literate. In all, 67.2% of all tiger attacks occurred as a result of illegal forest entry. The main livelihood of the former husbands of the widows were 43.8% wood cutting, 28.1% fishing, 10.9% crab catching, 9.4% tiger prawn seed (juvenile prawn), and 4.7% honey collection. The maximum number of attacks took place in the months of December (24.6%) and November (13.9%). The majority of incidences happened during the morning hours (47.7%) of the day. Of the cases, 86.1% were attacked while the person was engaged in livelihood activity. In all, 57.4% widows are recorded as living "below the poverty line". Currently, 45.5% widows earn their living by laboring work followed by forest-based livelihood activities (30%) and begging (5.2%). Tiger-widows differed significantly (P < 0.001) from both normal and snake-bite widows on all stigma cluster scores and the total score. Of the tiger-widows, 44% were shown to be suffering from some designated mental illness. IDIs and FGDs helped to unfold the cultural construct of stigma related to tiger-killing. This can be seen in how the tiger-widows' quality of life has been negatively impacted in the way their economic and social security, health, remarriage opportunities, and child upbringing is restricted, along with a multitude of posttrauma psychological scars, deprivation, abuse, and exploitation. CONCLUSIONS: The study highlights the multitude of sufferings experienced by the tiger-widows including the issues of the gender aspect of HTC and the ecopsychiatric risk factors of tiger attacks combined with the background of local sociocultural beliefs and practices. It is well known that a similar problem also exists in Bangladesh Sundarban as well, in which case it may be that a strong and practical administrative strategy for sustainable alternative income generation and a balanced conservation policy with integrated participatory forest management may go to save both human and tiger. A community ecocultural mental health program involving all the stakeholders (community, gram panchayat, and forest department) and aiming to address and even eradicate the cultural stigma of tiger attack may help to reduce the stigma burden and socicultural discrimination currently experienced by the tiger-widows.

Participatory Research for Preventing Pesticide-Related DSH and Suicide in Sundarban, India: A Brief Report.

Deliberate self-harm (DSH) is a major public health problem in the Sundarban region, India. This study is aimed to develop a DSH-suicide prevention programme based on the principles of community-based participatory research (CBPR). Perception and opinion of community about the problem of pesticide-related DSH and suicide were elicited in a series of facilitated focus group discussions in Namkhana block of Sundarban region. Based on their suggestion, a broad preventive programme was launched involving the development of information, education, and communication (IEC) and training modules and training of the stakeholders of the block. Most of the members of each target group found that the IEC materials were culture fair (message is acceptable, understandable, and meaningful in the local context) and very useful. Analysis of Dwariknagar BPHC, DSH admission data showed a definite reduction of DSH incidents after this CBPR approach to prevention was initiated. Similar model of DSH prevention in the other blocks of Sundarban region or in agricultural community may help to reduce the enormous mortality and morbidity from pesticide-related DSH and suicide.

Pattern of domestic violence amongst non-fatal deliberate self-harm attempters: A study from primary care of West Bengal.

OBJECTIVE: Evaluation of various clinico-demographic variables and pattern of domestic violence in non-fatal deliberate self-harm (DSH) attempters admitted in 3 Block Primary Health Centers (BPHC) of Sundarban region of West Bengal, India in the year 2002. MATERIALS AND METHODS: A prospective study of 89 DSH cases admitted at 3 Sundarban BPHCs by using a specially designed DSH register and a questionnaire on domestic violence in Bengali along with detail clinical interview. RESULTS: Among the total of 89 DSH cases (23 male and 66 female), young (less than 30 years), female sex, low education and married status constituted major part of the sample. Pesticide poisoning was the commonest mode of DSH attempt. Typical stressors found were marital conflict or conflict with in-laws or guardian. A majority of DSH attempters (69.6%) experienced more than one form of domestic violence. Poverty and unemployment in the family were strongly associated with domestic violence. Among female DSH attempters, the most common perpetrator was husband (48.48%) followed by in-laws (16.67%) and parent (34.78%) was the most common perpetrator among males. CONCLUSION: Both DSH and domestic violence are serious socio-clinical issue of a major public health concern in the Sundarban region. Stressful life situations and various types of victimizations in the family intermixed with easy availability of lethal pesticides in this agriculture dependent community may facilitate the impulse of self-harm behavior, especially among the young housewives. Timely psychosocial intervention through community psychiatry program may mitigate the impact of psycho-cultural stressors and thus may help to reduce the morbidity and mortality from DSH.

Deliberate self-harm and suicide by pesticide ingestion in the Sundarban region, India.

OBJECTIVE: To examine the clinical epidemiology, including case fatality and determinants of self-harm in six island blocks of the Sundarban region of West Bengal, India. METHODS: We examined the clinical records of 1277 patients admitted for deliberate self-harm (DSH) to the six island hospitals from 1999 to 2001. RESULTS: 77.7% of the patients survived their attempt, 11.9% died and for 10.4% the outcome was not recorded. Women accounted for 65.2% of the DSH admissions and 67.1% of the deaths. Pesticides were the most commonly used means (88.7%). The case fatality of self-harm reported in these hospitals ranged from 6.0% to 50.0% (mean 13.3%; CI, 11.3-15.3). The age group 55-64 years was at highest risk of death, the age group 15-24 years at lowest risk. Higher lethality of pesticide ingestion compared to other methods was suggestive but not significant. Case fatality within the region varied but was high compared to industrialized nations. Case records and management of DSH were poor. CONCLUSION: Effective DSH prevention in the Sundarban region would require better surveillance at clinical facilities and an intersectoral approach, linking the agricultural interests of pesticide safety and mental health interests for preventing DSH.

Eco-psychiatry and Environmental Conservation: Study from Sundarban Delta, India.

AIMS: This study attempts to examine the extent and impact of human-animal conflicts visa-vis psychosocial stressors and mental health of affected people in two villages adjacent to Sundarban Reserve Forest (SRF) in the Gosaba Block, West Bengal, India. METHODS: Door to door household survey for incidents of human-animal conflicts, Focus Group Discussions, In-depth Interviews, Case studies, Community Mental health clinics and participatory observation. RESULTS: A total of 3084 households covering a population of 16,999 were surveyed. 32.8% people live on forest-based occupation. During the last 15 years 111 persons (male 83, female 28) became victims of animal attacks, viz, Tiger (82%), Crocodile (10.8%) and Shark (7.2%) of which 73.9% died. In 94.5% cases the conflict took place in and around the SRF during livelihood activities. Tracking of 66 widows, resulted from these conflicts, showed that majority of them (51.%) are either disabled or in a very poor health condition, 40.9% are in extreme economic stress and only 10.6% remarried. 1 widow committed suicide and 3 attempted suicide. A total of 178 persons (male 82, female 96) attended the community mental health clinics. Maximum cases were Major Depressive Disorder (14.6%), followed by Somatoform Pain Disorder (14.0%), Post Traumatic Stress Disorder-animal attack related (9.6%) and Adjustment Disorder (9%). 11.2% cases had history of deliberate self-harm attempt, of which 55% used pesticides. CONCLUSIONS: Improvement of quality of life of this deltaic population by appropriate income generation and proper bio-forest management are the key factors to save their life as well as the mangrove environment of the Sundarban region.

Pesticide practices and suicide among farmers of the sundarban region in India.

BACKGROUND: Deliberate self-poisoning by ingesting pesticides is a serious health problem among farmers, especially in low- and middle-income countries. Preventing these suicides is a priority for a public mental health agenda. OBJECTIVE: To examine the role of pesticide poisoning in suicide and nonfatal deliberate self-harm, and clarify awareness of risks, safe practices concerning storage and use of pesticides, and associated self-injury, both unintentional and intentional, within farmer households of the Sundarban region, India. METHODS: Retrospective record review of adult cases of deliberate self-poisoning at the Block Primary Health Centres of 13 Sundarban Blocks was performed to analyze the relative roles of various methods of self-harm and their lethality. Focus group discussions, questionnaires, and in-depth interviews were undertaken in a community study of farmer households to examine pesticide-related views and practices, with particular attention to storage, use, and health impact. RESULTS: Pesticide poisoning was the most common method of deliberate self-harm in both men and women. Pesticide storage in most households was unsafe and knowledge was inadequate concerning adverse effects of pesticides on health, crops, and the environment. CONCLUSIONS: An intersectoral approach linking the interests of public health, mental health, and agriculture is well suited to serve the collective interests of all three agendas better than each in isolation. Such an approach is needed to reduce morbidity and mortality from unintentional and intentional self-injury in low-income agricultural communities like those of the Sundarban region.

Pesticide poisoning in non-fatal deliberate self-harm: A public health issue: Study from Sundarban delta, India.

BACKGROUND: Non-fatal deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture, and these agents are most frequently used in DSH. AIM: This study aimed to identify the nature of methods and agents used in non-fatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal. MATERIALS AND METHODS: Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres' (BPHCs') admission registers were analyzed. One Focus Group Discussion (FGD) with the Panchayat Samiti of each block (totally 13 FDGs) was conducted to elicit the Samiti members' perception about the problem of pesticide-related DSH or suicide in the region. RESULTS: A total of 5,178 (1,887 male and 3,291 female) subjects were admitted at the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning-prevention program with a special focus on improving clinical services, as well as initiating farmers' education programs focusing on safe pesticide practices at the primary-care level.